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2.
Curr Oncol ; 26(4): e571-e573, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31548826

RESUMO

Objective: Immune checkpoint inhibitors are now a standard of care for the management of many metastatic cancers, including non-small-cell lung cancer. Pembrolizumab, a selective anti-PD-1 monoclonal antibody, augments the host antitumoural response. This hyperactivation of the immune system has side effects, the so-called immune-related adverse effects. The objective of this case report was to review and point out a new pattern of immune checkpoint inhibitor-associated pneumonitis. Case Description: A 69-year-old woman with stage iv non-small-cell lung cancer receiving pembrolizumab presented for increased dyspnea. Pembrolizumab-related obstructive bronchiolitis was diagnosed based on a new severe obstructive disorder, without bronchodilator reversibility, and mosaic attenuation on angiography, without other identifiable causes. Summary: To our knowledge, this is the first description of a case of pembrolizumab-induced obstructive bronchiolitis. Various patterns of immune checkpoint inhibitor-associated lung disease have been described, and bronchiolitis should be included in the differential diagnosis.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Bronquiolite Obliterante/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Bronquiolite Obliterante/induzido quimicamente , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X
3.
Nucl Med Commun ; 40(7): 703-710, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31022070

RESUMO

OBJECTIVE: To evaluate the diagnostic value of function volume/morphological volume ratio calculated from ventilation/perfusion single-photon emission computed tomography/computed tomography in distinguishing the lungs with bronchiolitis obliterans syndrome (BOS) from the lungs without this syndrome after lung transplantation and to assess its relationship with spirometry parameters. MATERIALS AND METHODS: We retrospectively identified 84 consecutive lung transplant recipients and 13 donors who underwent ventilation/perfusion single-photon emission computed tomography/computed tomography. Differences in the function volume/morphological volume ratio of unilateral lungs were tested for significance between the lungs with and without BOS. Receiver operating characteristics and correlations between function volume/morphological volume ratios of bilateral lungs and forced expiratory volume in 1 s, forced vital capacity, and total lung capacity were analyzed. RESULTS: The function volume/morphological volume ratios of ventilation and perfusion images of unilateral lungs were significantly lower in lungs with BOS (each P<0.0001). The area under the curve values of ventilation and perfusion images were 0.97 and 0.99, respectively. Significant correlations were identified between the function volume/morphological volume ratios of ventilation and perfusion images and forced expiratory volume in 1 s (r=0.54, P<0.0001 and r=0.45, P<0.0001, respectively). The function volume/morphological volume ratio of ventilation image had a significantly weak correlation with forced vital capacity. CONCLUSION: The function volume/morphological volume ratio enables a semiquantitative assessment of ventilation and perfusion lung functions and is useful for diagnosing BOS after lung transplantation.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/etiologia , Transplante de Pulmão/efeitos adversos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Relação Ventilação-Perfusão , Adolescente , Adulto , Idoso , Bronquiolite Obliterante/patologia , Bronquiolite Obliterante/fisiopatologia , Criança , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Adulto Jovem
4.
Clin Exp Dermatol ; 44(8): 897-902, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30908698

RESUMO

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are characterized by widespread skin and mucosal blistering and necrosis. The triggers and long-term sequelae in children may differ from those reported for adults. Bronchiolitis obliterans (BO) is an uncommon complication, with only 15 previously reported cases, but can lead to significant long-term morbidity, requiring lung transplantation in some cases. We report three children with nondrug-related SJS (n = 1) and TEN (n = 2) who developed BO. Two were treated with intravenous immunoglobulin therapy (2-2.4 g/kg) and all three survived. We highlight salient learning points from our cases and potential pitfalls in diagnosis of BO, including delayed onset, and we also review the literature.


Assuntos
Bronquiolite Obliterante/etiologia , Síndrome de Stevens-Johnson/complicações , Adolescente , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/terapia , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Pulmão/diagnóstico por imagem , Masculino , Testes de Função Respiratória , Tomografia Computadorizada por Raios X
5.
Am J Case Rep ; 20: 171-174, 2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30737366

RESUMO

BACKGROUND Bronchiolitis obliterans is the term used to describe a clinical syndrome of irreversible airflow obstruction. Among the etiologies linked to this entity is the rarely reported association with Stevens-Johnson syndrome, which has had a poor outcome in most of the previously published cases. The optimum management of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome is not well defined. CASE REPORT A 41-year-old woman developed significant shortness of breath 3 months after recovering from Stevens-Johnson syndrome precipitated by a second-generation cephalosporin. She was found to have severe irreversible airway obstruction on physiology studies, and computed tomography scans of the inspiratory and expiratory phases of respiration showed air trapping that was more prominent on expiratory films. The patient was diagnosed with bronchiolitis obliterans, for which bronchodilators and long-term macrolide therapy were administered. Although she did not recover completely, her follow-up physiology studies showed that the bronchiolitis obliterans was stable. CONCLUSIONS Bronchiolitis obliterans secondary to Stevens-Johnson syndrome is a rare entity that is progressive and can lead to functional impairment. Identifying the disease at an early stage might stabilize or slow its progression. Herein, we describe a case of bronchiolitis obliterans as a complication of Stevens-Johnson syndrome and review the literature to raise awareness of this condition, highlight its course, and discuss the available treatments.


Assuntos
Antibacterianos/efeitos adversos , Bronquiolite Obliterante/etiologia , Cefuroxima/efeitos adversos , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/etiologia , Adulto , Bronquiolite Obliterante/diagnóstico por imagem , Feminino , Humanos
7.
Transplantation ; 103(4): 823-831, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30086092

RESUMO

BACKGROUND: Differential diagnosis of phenotypes of chronic lung allograft dysfunction (CLAD) remains troublesome. We hypothesized that F-fluorodeoxyglucose positron emission tomography with computed tomography (F-FDG PET/CT) may help in differential diagnosis of CLAD phenotypes, as it showed promising results regarding diagnosis and prognosis in interstitial lung diseases. METHODS: A monocentric, retrospective study was performed including all lung transplant recipients suffering from bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS) who underwent F-FDG PET/CT scan, in comparison with stable lung transplant recipients. Maximum standardized uptake value (SUVmax) was associated with pulmonary function and survival. Proof-of-concept microCT and glucose transporter-1 staining served as morphologic validation for regions with different SUVmax. RESULTS: Maximum standardized uptake value was higher in RAS (median, 2.6; n = 29) compared with BOS (median, 1.0; n = 15) and stable patients (median, 0.59; n = 8) (P < 0.0001). In RAS, high SUVmax was associated with worse survival after F-FDG PET/CT (P = 0.0004; hazard ratio, 1.82). Forced vital capacity at F-FDG PET/CT inversely correlated with SUVmax (R = -0.40, P = 0.03). MicroCT analysis revealed extensive fibrosis in regions of high SUVmax, with an increased number of glucose transporter-1-positive cells. CONCLUSIONS: F-fluorodeoxyglucose positron emission tomography with CT may noninvasively differentiate RAS from BOS. RAS patients with areas of increased lung metabolism have worse outcome, demonstrating the potential use of F-FDG PET/CT during follow-up after lung transplantation.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Fluordesoxiglucose F18 , Transplante de Pulmão/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Adulto , Bronquiolite Obliterante/fisiopatologia , Feminino , Volume Expiratório Forçado , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Microtomografia por Raio-X
8.
J Clin Rheumatol ; 25(2): 74-77, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29596206

RESUMO

OBJECTIVE: Constrictive bronchiolitis (CB) is a poorly understood pulmonary manifestation of primary Sjögren syndrome (pSS). We aimed to clarify the presenting clinicoradiologic features and clinical course of pSS-associated CB through a retrospective cohort study. METHODS: We retrospectively identified 11 patients with pSS and CB (defined by mosaic pattern with air trapping on computed tomography) encountered at our institution over 9 years from 2007 to 2015. Presenting clinical features, laboratory results, radiologic findings, and clinical course were analyzed. RESULTS: Our patients were mostly women (91%), with a median age 53 years (range, 31-76 years) at the time of pulmonary symptom (dyspnea or cough) onset. Most (64%) were nonsmokers. Average interval between diagnosis of pSS and the onset of pulmonary symptoms was 4.4 years; in 4 patients (36%), CB was the presenting manifestation of pSS. Chest radiographs were normal (67%) or demonstrated hyperinflation (33%). Pulmonary function testing demonstrated airflow obstruction in 7 patients (63%), and 2 patients (18%) had an isolated reduction in diffusing capacity, whereas the remaining 2 patients manifested mixed physiology or normal results. Surgical lung biopsy was performed in 2 patients and confirmed the diagnosis of CB in both. Treatment was variable among our patients included glucocorticoids, hydroxychloroquine, mycophenolate mofetil, and cyclophosphamide. Among 6 patients with follow-up computed tomography and pulmonary function, the results remained stable or worsened. CONCLUSIONS: Constrictive bronchiolitis is a rare extraglandular manifestation and can sometimes be the presenting manifestation of pSS. This pulmonary manifestation is associated with an indolent clinical course and does not respond well to immunosuppressive therapy.


Assuntos
Bronquiolite Obliterante/complicações , Bronquiolite Obliterante/diagnóstico por imagem , Síndrome de Sjogren/complicações , Adulto , Idoso , Bronquiolite Obliterante/fisiopatologia , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Sjogren/diagnóstico por imagem , Síndrome de Sjogren/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
BMC Infect Dis ; 18(1): 529, 2018 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-30348093

RESUMO

BACKGROUND: Adenoviruses (AdV) are non-enveloped, double-stranded DNA viruses with multiple serotypes, which cause a variety of end-organ disease in both immunocompetent and immunocompromised individuals. Some adenoviruses can become latent in the mucosa-associated lymphoid tissue (e.g. adenoids and tonsils), with the potential to reactivate sporadically, leading to upper or lower respiratory tract infection and disease. Bronchiolitis Obliterans (BO) is a rare chronic lung disorder which usually follows a severe insult to the respiratory tract. In children, it is a complication of severe infections (as post-infectious BO), typically manifesting after a severe respiratory infection, in previously healthy pre-school children. Symptoms and signs of air trapping (hyperinflated chest, expiratory wheeze) with persistent oxygen requirement are characteristic. The presence of the unusual mosaic tetrasomy 9p genotype in this case, despite standard cidofovir therapy for persistent or chronic adenovirus infection, may have impacted on the child's long-term clinical outcomes. CASE PRESENTATION: We present a case of persistent AdV B3 infection in a 14-month old boy with mosaic tetrasomy 9p, which persisted for 10 weeks, resulting in radiologically-confirmed BO, requiring cidofovir to control the persistent AdV B3 infection and standard therapy with pulsed steroids. We argue that in the presence of the mosaic tetrasomy 9p, earlier antiviral therapy may have decreased the severity of BO, as this mutation is known to be associated with some degree of immune dysregulation. CONCLUSIONS: Adenovirus infections are common in children and may persist as latent infections, with subsequent reactivations during loss of immune control, related to systemic illness arising from other causes. In chronic, reactivated AdV infection with pneumonia, BO is a recognised complication. However, in this case, with the presence of the mosaic tetrasomy 9p mutation, earlier antiviral therapy may have reduced such longer term complications, due to the immune dysregulatory nature of this mutation.


Assuntos
Infecções por Adenoviridae/diagnóstico , Aneuploidia , Antivirais/uso terapêutico , Bronquiolite Obliterante/patologia , Cidofovir/uso terapêutico , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/complicações , Infecções por Adenoviridae/tratamento farmacológico , Infecções por Adenoviridae/virologia , Bronquiolite Obliterante/complicações , Bronquiolite Obliterante/diagnóstico por imagem , Cromossomos Humanos Par 9 , Humanos , Hospedeiro Imunocomprometido , Lactente , Masculino , Mosaicismo , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
10.
Eur J Radiol ; 106: 137-144, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30150035

RESUMO

PURPOSE: To evaluate quantitative computed tomography (CT) measurements of the lung parenchyma in lung transplant (LTx) patients for early detection of the bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: 359 CT scans of 122 lung transplant patients were evaluated. Measurements of lung volume and density were performed for the whole lung and separately for each lobe. For longitudinal analysis the difference between the baseline at 6 months after LTx and follow-up examinations was calculated. Patients with and without BOS (matched 1:2) were compared at two different time points, the last examination before the BOS onset and the first examination within one year after BOS onset. RESULTS: 30 patients developed BOS during the follow-up period. Longitudinal changes in the lung volume and lung density measured on CT differed significantly between those patients with and without early BOS, in particular the difference of the inspiratory and expiratory lung volume (p < 0.001), the ratio of the expiratory and inspiratory lung volume (p < 0.001-p = 0.001) and MLD (p < 0.001-p = 0.001), the volume on expiration (p < 0.001-p = 0.007), the MLD on expiration (p < 0.001-p = 0.007), and the percentiles on expiration (p < 0.001-p = 0.002) with an increase of lung volume and a decrease of lung density. Changes were pronounced in the lower lobes. Before BOS onset, patients with and without future development of BOS showed no significant differences. CONCLUSION: Longitudinal changes of lung volume and lung density measured on CT start markedly at BOS onset with increased lung volume and decreased lung density indicating increased inflation levels. Even though this method may help to diagnose BOS at onset it is not useful as a predictor for BOS before disease onset.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/patologia , Transplante de Pulmão , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Diagnóstico Precoce , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Prospectivos , Adulto Jovem
11.
Am J Ind Med ; 61(10): 793-801, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30117179

RESUMO

Constrictive Bronchiolitis (CB) has been reported in US Operation Iraqi Freedom/Enduring Freedom (OIF/OEF) deployers but not in those from prior US conflicts. A 62-year old presented with progressive dyspnea 13 years after deployment to the Persian Gulf in 1991-1992, where he was exposed to burning oil well fire emissions, dust storms, and other potential airborne hazards. In 2014, after a chest computed tomography (CT) scan demonstrated diffuse mosaic attenuation, he underwent surgical lung biopsy, which revealed CB. Deployers from both GWI and OIF/OEF share many exposures. As respiratory symptoms are a feature associated with Gulf War medically unexplained illness, there may be a role for renewed interest in evaluating GWI Veterans with unexplained respiratory symptoms for conditions such as CB, which may result from exposures relevant to deployers from both conflicts.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Guerra do Golfo , Exposição Ocupacional , Veteranos , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Biópsia , Bronquiolite Obliterante/patologia , Bronquiolite Obliterante/fisiopatologia , Bronquiolite Obliterante/terapia , Fogo , Volume Expiratório Forçado , Humanos , Exposição por Inalação , Masculino , Pessoa de Meia-Idade , Campos de Petróleo e Gás , Capacidade de Difusão Pulmonar , Terapia Respiratória , Tomografia Computadorizada por Raios X , Capacidade Vital
12.
Rev. chil. enferm. respir ; 34(2): 95-101, ago. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-959413

RESUMO

Resumen La principal complicación a largo plazo en trasplantados de pulmón es la disfunción crónica de injerto identificado como bronquiolitis obliterante, existiendo un nuevo patrón denominado Disfunción de Injerto Restrictivo. Objetivo: Evaluar seguimiento espirométrico, radiológico y clínico entre pacientes con síndrome de bronquiolitis obliterante (SBO) y Disfunción de Injerto Restrictivo (DIR) post trasplante pulmonar. Metodología: Se revisaron registros clínicos de trasplantados pulmonares desde 1999 hasta 2017. Se efectuó seguimiento espirométrico e imágenes por tomografía de tórax y factores asociados: infección por Citomegalovirus(CMV), reflujo gastro-esofágico (RGE) y episodios de rechazo agudo. Se analizó sobrevida por Kaplan Meier. Resultados: De 88 pacientes trasplantados de pulmón, 40 desarrollaron disfunción crónica de injerto: 31 (80%) presentaron SBO y 9 (20%) tuvieron DIR. Edad promedio: 47 años en SBO y 46 años en DIR. Siendo fibrosis pulmonar la patología basal predominante en ambos. En SBO se consignaron 14 episodios de rechazo agudo (50%), infección por CMV en 18% y RGE activo en 26%. En la serie DIR hubo 5 episodios de rechazo agudo (62%), 13% de infección por CMV y 67% de RGE activo 6 (p = 0,02). En el seguimiento a 1-2-4-5 años el promedio del VEF1 en SBO fue: 67,3,65, 60 y 48% del valor predicho y en DIR fue 61, 65, 62 y 45% respectivamente. Las imágenes tomográficas en SBO mostraron: hiperinflación y en DIR: fibrosis pleuropulmonar superior. La sobrevida fue de 96,9 meses en SBO y 65,6 meses en DIR (p = 0,06). Conclusions: La disfunción restrictiva presentó menor sobrevida que SBO. RGE se asoció a rechazo restrictivo. La tomografía de tórax difiere en ambos tipos de rechazo crónico.


The main long-term complication in lung transplant patients is chronic graft dysfunction identified as bronchiolitis obliterans, and there is a new pattern called Restrictive Graft Dysfunction. Objective: To evaluate spirometric, radiological and clinical follow-up among patients with bronchiolitis obliterans syndrome (BOS) and Restrictive Allograft Syndrome (RAS) after lung transplantation. Methodology: Lung transplant recipients ' clinical records were reviewed from 1999 to 2017. We carried out a follow up of spirometry, chest tomography imaging and associated factors: cytomegalovirus (CMV) infection, gastroesophageal reflux (GER) and episodes of acute rejection. Survival was analyzed by Kaplan Meier. Results: Out of 88 lung transplant patients, 40 developed chronic graft dysfunction: 31 (80%) presented BOS and 9 (20%) had RAS. Mean age: 47 yr.o. in BOS and 46 yr. o. in RAS. Lung fibrosis was the primary pathology predominant in both conditions. In BOS were reported 14 episodes of acute rejection (50%), CMV infection in 18% and active GER in 26%. In RAS there were 5 episodes of acute rejection (62%), CMV infection in 13% and active GER in 67% (p = 0.02). VEF1 follow-up at 1-2-4-5 years averaged 67, 65, 60 and 8% of reference value in BOS and 61, 65, 62 and 45% in RAS respectively. CT scans showed hyperinflation in BOS and upper pleuropulmonary fibrosis in RAS. BOS survival time was 96.9 months versus 65.6 months in RAS (p = 0.06). Conclusiones: Restrictive dysfunction presented a lower survival rate than BOS. GER was associated with restrictive rejection. Chest tomography differs in both types of chronic rejection.


Assuntos
Humanos , Adulto , Bronquiolite Obliterante/etiologia , Bronquiolite Obliterante/diagnóstico por imagem , Refluxo Gastroesofágico/diagnóstico , Transplante de Pulmão/métodos , Infecções por Citomegalovirus/virologia , Disfunção Primária do Enxerto/etiologia , Aloenxertos , Tórax/diagnóstico por imagem , Bronquiolite Obliterante/patologia , Refluxo Gastroesofágico/complicações , Tomografia Computadorizada por Raios X , Taxa de Sobrevida , Caminhada , Dados Demográficos , Infecções por Citomegalovirus/patologia , Infecções por Citomegalovirus/epidemiologia , Disfunção Primária do Enxerto/patologia
13.
BMC Pulm Med ; 18(1): 105, 2018 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-29929518

RESUMO

BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune condition characterized by erosive inflammation of the joints. One rare pulmonary manifestation is obliterative bronchiolitis (OB), a small airways disease characterized by the destruction of bronchiolar epithelium and airflow obstruction. METHODS: We retrospectively reviewed the clinical data of patients with rheumatoid arthritis-associated obliterative bronchiolitis (RA-OB) from 01/01/2000 to 12/31/2015. Presenting clinical features, longitudinal pulmonary function testing, radiologic findings, and independent predictors of all-cause mortality were assessed. RESULTS: Forty one patients fulfilled criteria for diagnosis of RA-OB. There was notable female predominance (92.7%) with a mean age of 57 ± 15 years. Dyspnea was the most common presenting clinical symptom. Median FEV1 was 40% (IQR 31-52.5) at presentation, with a mean decline of - 1.5% over a follow-up period of thirty-three months. Associated radiologic findings included mosaic attenuation and pulmonary nodules. A majority of patients (78%) received directed therapy including long-acting inhalers, systemic corticosteroids or other immunosuppressive agents, and macrolide antibiotics. All-cause mortality was 27% over a median follow-up of sixty-two months (IQR 32-113). No distinguishable predictors of survival at presentation were found. CONCLUSIONS: RA-OB appears to have a stable clinical course in the majority of patients despite persistent symptoms and severe obstruction based on presenting FEV1.


Assuntos
Artrite Reumatoide/complicações , Bronquiolite Obliterante/complicações , Pulmão/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/terapia , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Mortalidade , Modelos de Riscos Proporcionais , Testes de Função Respiratória , Estudos Retrospectivos , Adulto Jovem
14.
AJR Am J Roentgenol ; 211(1): W13-W21, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29792746

RESUMO

OBJECTIVE: The purpose of this article is to review the high-resolution CT characteristics of individual obstructive and restrictive chronic lung allograft dysfunction (CLAD) phenotypes to aid in making accurate diagnoses and guiding treatment. CONCLUSION: Long-term survival and function after lung transplant are considerably worse compared with after other organ transplants. CLAD is implicated as a major limiting factor for long-term graft viability. Historically thought to be a single entity, bronchiolitis obliterans syndrome, CLAD is actually a heterogeneous group of disorders with distinct subtypes.


Assuntos
Transplante de Pulmão , Complicações Pós-Operatórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Bronquiolite Obliterante/diagnóstico por imagem , Rejeição de Enxerto/diagnóstico por imagem , Humanos , Fenótipo , Testes de Função Respiratória , Fatores de Risco , Síndrome , Transplante Homólogo
16.
Clin Transplant ; 32(5): e13233, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29637624

RESUMO

Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub-divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader-independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival. A retrospective study evaluated CT scans corresponding to CLAD onset using pulmonary function tests in 74 patients (23 RAS, 51 BOS). Two different QDM values (QDM1 and QDM2) were calculated using CT lung density histograms. Calculation of QDM1 includes the extreme edges of the histogram. Calculation of QDM2 includes the central region of the histogram. Kaplan-Meier analysis and Cox regression analysis were used for CLAD prognosis. Higher QDM values were significantly associated with decreased survival. The hazard ratio for death was 3.2 times higher at the 75th percentile compared to the 25th percentile using QDM1 in a univariate model. QDM may associate with CLAD patient prognosis.


Assuntos
Bronquiolite Obliterante/mortalidade , Rejeição de Enxerto/mortalidade , Pneumopatias/mortalidade , Transplante de Pulmão/mortalidade , Complicações Pós-Operatórias , Disfunção Primária do Enxerto/mortalidade , Tomografia Computadorizada por Raios X/métodos , Adulto , Aloenxertos , Bronquiolite Obliterante/classificação , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/etiologia , Doença Crônica , Feminino , Seguimentos , Rejeição de Enxerto/diagnóstico por imagem , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Disfunção Primária do Enxerto/classificação , Disfunção Primária do Enxerto/diagnóstico por imagem , Disfunção Primária do Enxerto/etiologia , Prognóstico , Radiografia Torácica , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco
18.
Radiología (Madr., Ed. impr.) ; 60(1): 39-48, ene.-feb. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170435

RESUMO

La patología de las vías respiratorias de medio calibre (bronquios segmentarios y subsegmentarios) es común y se presenta con síntomas respiratorios poco específicos, como tos, infecciones de repetición y en ocasiones hemoptisis. La dilatación permanente del árbol bronquial se conoce como «bronquiectasia» y representa un reto diagnóstico. El análisis de la distribución regional de las bronquiectasias en los diferentes lóbulos pulmonares es la guía diagnóstica más útil. El objetivo de este trabajo es describir los hallazgos de imagen de las bronquiectasias y sus diferentes tipos, revisar las situaciones más comunes y proponer un algoritmo diagnóstico basado en su distribución anatómica. Las bronquiectasias son un hallazgo frecuente, resultado de un amplio espectro de enfermedades. Los estudios de imagen desempeñan un papel esencial en su detección, clasificación y orientación diagnóstica hacia la patología subyacente (AU)


Diseases that involve the medium caliber airways (segmental and subsegmental bronchi) are common and present clinically with nonspecific respiratory symptoms such as cough, recurrent respiratory infections and occasionally, hemoptysis. The abnormal and irreversible dilation of bronchi is known as "bronchiectasis". The diagnosis can be challenging and the analysis of the regional distribution of the bronchiectasis is the most useful diagnostic guide. The objective of this manuscript is to describe the main imaging findings of bronchiectasis and their classification, review the diseases that most commonly present with this abnormality, and provide an approach to the diagnosis based on their imaging appearance and anatomic distribution. Bronchiectasis is a frequent finding that may result from a broad range of disorders. Imaging plays a paramount role in diagnosis, both in the detection and classification, and in the diagnosis of the underlying pathology (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Bronquiectasia/diagnóstico por imagem , Fibrose Cística/diagnóstico por imagem , Bronquite Crônica/diagnóstico por imagem , Fibrose Pulmonar/diagnóstico por imagem , Bronquiectasia/classificação , Broncopatias/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Transplante de Pulmão , Bronquiolite Obliterante/diagnóstico por imagem
19.
J Thorac Imaging ; 33(2): 112-123, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29135627

RESUMO

PURPOSE: Bronchiolitis obliterans syndrome after lung transplantation (LTx) manifests as a sustained decline in forced expiratory volume in the first second (FEV1). Quantitative computed tomography (QCT) metrics may predict FEV1 better than semiquantitative scores (SQSs), and the transplanted lung may provide better information than the native lung in unilateral LTx. MATERIALS AND METHODS: Paired inspiratory-expiratory CT scans and pulmonary function testing of 178 LTx patients were analyzed retrospectively. SQS were graded (absent, mild, moderate, severe) for features including mosaic attenuation and bronchiectasis. QCT included lung volumes and air-trapping volumes, by lobe. Multivariate Pearson correlation and multivariate linear least squares regression analyses were performed. RESULTS: Multivariate linear least squares regression models using FEV1 as the outcome variable and SQS or QCT metrics as predictor variables demonstrated SQS to be a weak predictor of FEV1 (adjusted R, 0.114). QCT metrics were much stronger predictors of FEV1 (adjusted R, 0.654). QCT metrics demonstrated stronger correlation (r) with FEV1 than SQS. In bilateral LTx, whole lung volume difference (r=0.69), left lung volume difference (r=0.69), and right lung volume difference (r=0.65) were better than the sum of SQS (r=-0.54). Interestingly, in left LTx we obtained r=0.81, 0.86, 0.25, and -0.39, respectively. In right LTx, we obtained r=0.69, 0.49, 0.68, and -0.31, respectively. CONCLUSIONS: QCT metrics demonstrate stronger correlations with FEV1 and are better predictors of pulmonary function than SQS. SQS performs moderately well in bilateral LTx, but poorly on unilateral LTx. In unilateral LTx, QCT metrics from the transplanted lung are better predictors of FEV1 than QCT metrics from the nontransplanted lung.


Assuntos
Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/fisiopatologia , Transplante de Pulmão , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo , Adulto Jovem
20.
Transplantation ; 102(2): e49-e58, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28825953

RESUMO

BACKGROUND: Several mouse lung transplantation (Tx) models have been proposed for the study of chronic airway fibrosis (CAF), the most prevalent complication seen in human lung transplant recipients, termed chronic lung allograft dysfunction. Alternatively, it has been called for to establish an experimental animal model for restrictive allograft syndrome, another phenotype of chronic lung allograft dysfunction. However, these mouse transplant models exhibit significant heterogeneity in consistency and reproducibility. We therefore aimed at reevaluating current available models. METHODS: Four different Tx combinations were used that manifest CAF: 2 minor antigen-mismatched Tx combinations (MINOR, donor: C57BL/10, recipient: C57BL/6J); or MINOR-N using recipient C57BL/6N, major histocompatibility antigen-mismatched immunosuppressed Tx (MAJOR, donor: BALB/c, recipient: C57BL/6J), and syngeneic Tx (donor and recipient: C57BL/6J) as control. The recipients were harvested and analyzed at week 8. Oxygenation, histology, reverse transcription polymerase chain reaction, and magnetic resonance imaging were performed to analyze outcome of those models. RESULTS: The most prominent manifestation of CAF, thickest subepithelial fibrotic changes, worst oxygenation, and the most severe acute rejection were detected in the MAJOR group compared with all other (P < 0.05). Gene expressions of TNF-α and TGF-ß1 were higher, and IL-10 was lower in the MAJOR group. Immunohistochemistry found pleuroparenchymal fibrotic change in both the MAJOR and MINOR-J groups. CONCLUSIONS: We propose the major mismatch model under mild immunosuppression as the most suitable model for studying posttransplant CAF, and both the major and minor mismatch models for the restrictive phenotype.


Assuntos
Bronquiolite Obliterante/etiologia , Transplante de Pulmão/efeitos adversos , Pulmão/patologia , Complicações Pós-Operatórias/etiologia , Animais , Bronquiolite Obliterante/diagnóstico por imagem , Doença Crônica , Modelos Animais de Doenças , Fibrose , Imagem por Ressonância Magnética , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Complicações Pós-Operatórias/diagnóstico por imagem
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